Paths to literacy and numeracy problems: evidence from two British birth cohorts

BACKGROUND

To test a life course model linking circumstances of origin to self-reported literacy and numeracy problems in midlife, and to investigate the effects in this model of changing social circumstances in two post-war cohorts.

METHODS

Based on data from men and women in the British 1946 and 1958 birth cohorts, we used the relative index of inequality and logistical regression to test associations between father's occupation, childhood cognition, educational attainment, own occupation in the third decade, and a binary variable representing self-reported literacy and numeracy problems in the fourth decade.

RESULTS

There was a lower frequency of literacy and numeracy problems in the 1958 cohort than in the 1946 cohort. In both cohorts there were associations between father's occupation and childhood cognition, educational attainment and own occupation, a pattern that was mirrored by the associations between childhood cognition, educational attainment and own occupation to adult literacy and numeracy problems. Positive associations between childhood cognition and educational attainment, and between educational attainment and own occupation, were stronger in the 1946 cohort than in the 1958 cohort. However, inverse associations between educational attainment and literacy and numeracy problems were stronger in the 1958 cohort, possibly reflecting the expansion of secondary education in the intervening years.

CONCLUSIONS

Literacy and numeracy problems have a robust structure of life course associations, although the changing pattern of these associations may reflect important social structural changes from the early post-war years to the early 1960s in the UK.

Primary headaches in HIV-infected patients

Headache in patients with human immunodeficiency virus (HIV) infection may indicate life-threatening illnesses such as opportunistic infections or neoplasms. Alternatively, such patients may develop benign self-limiting headaches. Hence, defining the various types of headache in these patients is essential for proper management. This study describes the clinical characteristics of primary headaches occurring in a group of HIV-infected patients. Of 115 patients seen from 1990 to 1996, 44 (38%) had headaches. Primary headaches were present in 29 (66%) patients and secondary causes were identified in 15 (34%). Among those with primary headaches, migraine occurred in 22 (76%), tension-type headache in 4 (14%), and cluster headache in 3 (10%) patients. Half of those with migraine (n=ll), 1 patient with tension-type headache, and 1 patient with cluster headache developed chronic daily headaches which were severe and refractory to conventional headache or antiretroviral therapy. We conclude that primary headaches in patients with HIV infection are: (1) the commonest type of headache; (2) may present for the first time in individuals with severe immunosuppression; (3) usually bear no relationship to antiretroviral drug therapy; (4) polypharmacy, depression, anxiety, and insomnia are commonly associated comorbidities; (5) frequently do not respond to conventional management and carry a poor prognosis; and (6) do not require neuroradiological and/or cerebrospinal fluid evaluations.

Loss and representativeness in a biomedical survey at age 45 years: 1958 British birth cohort

OBJECTIVE

A biomedical survey of the 1958 British birth cohort at age 45 years provides a baseline for future studies of chronic disease. The extent and nature of bias in this sample was examined.

METHODS

Follow-up of all births in Great Britain in one week in March 1958. At 45 years the sample was compared with the surviving cohort on characteristics recorded at birth and seven years, and in adulthood (42 years).

RESULTS

Sample attrition to age 45 years was chiefly through avoidable (35.8%) than unavoidable loss through death or emigration (13.7%). 11 971 individuals were invited to participate at 45 years. Of 9377 participants (78.3%), most consented to, and had valid values for, physical and mental measurements, survey questionnaires, and blood and saliva sampling; 8302 (88.5%) provided a blood sample. Groups moderately underrepresented in the 45-year sample included those with externalizing or internalizing behaviours, poor reading or math scores, and shorter stature. For example, 8.8% of the 45-year sample had been poor readers at age seven years compared with 11.1% of the total surviving cohort; for shorter stature the figures were 7.2% versus 8.4%, respectively. There was also underrepresentation of some minority groups (non-whites, births in households with no male head and children in social care). Most bias was present before the 45-year survey.

CONCLUSION

The 45-year sample remains broadly representative of the surviving cohort, but specific biases may need to be taken into account in future research. Renewed efforts to re-engage all cohort members will improve the representativeness and value of the study.

Intra-operative examination of the sentinel node in breast cancer

Intra-operative sentinel node analysis allows immediate progression to axillary clearance in patients with node positive breast cancer and reduces the need for re-operation. Despite this, intra-operative sentinel node analysis is infrequently performed in Ireland. We report our experience using this technique. Sentinel node biopsy was performed in 47 consecutive patients with symptomatic T1-T2 clinically node negative breast cancer. Sentinel nodes were examined intra-operatively by frozen section and imprint cytology and definitive histological assessment was performed on paraffin-embedded tissue. The sentinel node was identified in 46 (98%) patients. Twelve patients had axillary metastases. The sensitivity of intra-operative analysis in identifying nodal metastases was 92%. False negative rate was 8%, negative predictive value 97%, and specificity 100%. Intra-operative analysis of the sentinel node allowed re-operation to be avoided in 92% of patients with axillary node metastases. In our experience this technique can be readily introduced with reliable outcomes.

Television viewing and obesity: a prospective study in the 1958 British birth cohort

OBJECTIVE

To assess whether frequency of television viewing in adolescence (11 and 16 years) or early adulthood (23 years) affected subsequent changes in body mass index (BMI) through to mid-adulthood life, and waist-hip ratio in mid-adulthood.

SUBJECTS

The 1958 British birth cohort includes all births in 1 week in March 1958 in England, Scotland and Wales. The main analyses included at least 11 301 participants. Outcome measures included BMI at 16, 23, 33 and 45 years and waist-hip ratio at 45 years.

RESULTS

Watching television 'often' at 16 years (but not 11 years) was associated with a faster gain in BMI between 16 and 45 years in males (0.011 kg m(-2) per year, 95% confidence interval (CI) 0.003, 0.019) and females (0.013 kg m(-2) per year, 95%CI 0.003, 0.023). More frequent television viewing at 11, 16 and 23 years was associated with a faster gain in BMI between 23 and 45 years in females, but not in males. Television viewing at 23 years was associated with waist-hip ratio at 45 years: participants watching > or = 5 times per week had a waist-hip ratio 0.01 higher than those watching less often. At 45 years, those watching television for > or = 4 h day(-1) had a waist-hip ratio 0.03-0.04 higher than those watching for <1 h day(-1).

CONCLUSIONS

More frequent television viewing in adolescence and early adulthood is associated with greater BMI gains through to mid-adulthood and with central adiposity in mid-life. Television viewing may be a useful behaviour to target in strategies to prevent obesity.

A comparative study of risk factors and prognostic features between symptomatic and screen detected breast cancer

AIMS

To compare prognostic factors in screen detected breast cancer (SDBC) and symptomatically presenting breast cancer (SBC).

METHODS

Data were examined on 100 SDBC and 100 SBC. Multiple clinical patient factors were assessed including histopathological features. Using the Gail model each patient's risk of developing breast cancer was calculated and these data were examined for differences between groups.

RESULTS

There was no difference in the mean age of patient presentation or in the risk of breast cancer development between groups (2.2% vs. 2.2%, SDBC vs. SBC, actuarial risk of cancer at 5 years). SDBC patients had a significantly lower grade (1.95 vs. 2.44, SDBC vs. SBC, P<0.05), a smaller size of tumour (15.4mm vs. 29.3mm, SDBC vs. SBC, P<0.05) and a higher rate of oestrogen (94% vs. 81%, P<0.05) and progesterone (75% vs. 52%, P<0.05) receptor positivity. When compared using the Nottingham Prognostic Index, SDBC was associated with a better prognosis (r=-0.444, P<0.001).

CONCLUSIONS

Though both groups have similar demographics and risk, SDBC patients appear to have more favourable prognostic features. This has implications for the application of systemic therapy in breast cancer and supports the observation that SDBC is a more indolent form of disease.

Diabetes risk in British adults in mid life: a national prevalence study of glycated haemoglobin

AIMS

Information on the population at risk of developing Type 2 diabetes in the UK is scarce. We used data from the 1958 British birth cohort to estimate geographical and socio-economic variations in HbA(1c) in mid life.

METHODS

Participants (n = 7799) born in England, Scotland and Wales and currently living in the UK. Individuals were classified according to the presence of Type 2 diabetes and by thresholds of HbA(1c). HbA(1c)> or = 5.5 was used as an indicator for possible subclinical alterations in glucose metabolism.

RESULTS

The majority of the population had HbA(1c) < 5.5% (79.3%); 16.7% had HbA(1c) 5.5-5.9%, 2.0% 6.0-6.9% and 0.6% had HbA(1c)> or = 7.0%. Individuals from manual socio-economic groups and those living in the East of England and Scotland had a higher prevalence of HbA(1c) at or above the upper normal range (5.5%).

CONCLUSIONS

Estimates from this nationwide sample suggest that a proportion of Britons are likely to have subclinical alterations in glucose metabolism by their mid 40s, and this proportion is greater in some socio-economic groups and geographical regions than in others.

Superiority of anti-reflux stent compared with conventional stents in the palliative management of patients with cancer of the lower esophagus and esophago-gastric junction: results of a randomized clinical trial

Palliation of inoperable esophageal cancer with covered stents aims to relieve progressive dysphagia and improve health-related quality of life (HRQoL). Introducing a stent across the esophagogastric junction in lower third tumors may predispose to unchecked gastro-esophageal reflux (GER). Esophageal stents incorporating an anti-reflux valve have been introduced to address this problem. We prospectively compared an anti-reflux stent with a standard stent in the palliation of inoperable lower third esophageal tumors. Forty-nine consecutive patients with malignant dysphagia were randomized to receive a standard (n = 25, group 1) or an anti-reflux stent (n = 24, group 2). HRQoL was assessed before stenting, at 1 week and at 2 months, utilizing European Organization for Research and Treatment of Cancer questionnaires QLQ-C30, QLQ-OES24 and reflux questionnaires. Esophageal pH testing was performed within 1 week of the stent insertion. Detailed statistical analysis was employed to assess general QoL, symptoms and pH scores in both groups. Both groups reported significantly improved QoL, health and dysphagia scores at 1 week and 2 months after stenting. Group 2 patients reported significantly (P < 0.05) better DeMeester symptom, general reflux scores, and normal pH profile at 1 week. At 2 months DeMeester symptom scores were significantly (P < 0.05) better in group 2 compared with group 1. Standard and anti-reflux stents afford comparable relief from dysphagia and improved quality of life in patients with inoperable lower third esophageal cancer. Anti-reflux stents, however, controlled symptomatic and physiologically relevant reflux and should therefore be considered as optimal palliation in this cohort.

Quantitative analysis of human endogenous retrovirus-W env in neuroinflammatory diseases

Although human endogenous retroviruses (HERVs) constitute 8% of the human genome, their role(s) in health and disease remain uncertain. Nonetheless, increased HERV gene activity has been reported in neuroinflammatory diseases such as multiple sclerosis (MS). The human endogenous retrovirus (HERV)-W7q envelope gene encodes a glycosylated envelope protein, syncytin-1, which is expressed in many tissues. Analysis of HERV envelopes (env) revealed a selectively increased abundance of syncytin-1 encoding RNA in brains from patients with MS (p<0.01) relative to non-MS patients. However, HERV env expression from blood-derived leukocytes did not differ between groups. A quantitative PCR-based assay for syncytin-1 RNA showed that median viral RNA levels were higher in brains of MS patients (5.0 log10 copies/microg RNA) relative to non-MS patients (4.6 log10 copies/microg RNA) (p<0.05). Median syncytin-1 DNA levels in MS brains (9.8 log10/microg DNA) were higher than non-MS brain tissue (7.9 log10/microg DNA) (p<0.001) without evidence of new integration events. In contrast, there were no differences in syncytin-1 RNA copy numbers between groups in both CSF (non-MS: 5.0 log10/ml versus MS: 3.8 log10/ml) and plasma (non-MS: 5.033 log10/ml versus MS: 2.9 log10/ml). These observations emphasize the selective induction of syncytin-1 in brain tissue of MS patients but also illustrate the complex dynamics of this retroelement in neuroinflammatory processes.

Drinking histories of self-identified lifetime abstainers and occasional drinkers: findings from the 1958 British Birth Cohort Study

AIMS

To investigate the validity of retrospective items used to distinguish people who have rarely or never consumed alcohol.

METHODS

The 1958 British Birth Cohort Study has followed 9377 individuals until age 45. Previous drinking (at 16, 23, 33 and 42 years) was investigated for two groups of 45-year-old non-drinkers, those reporting never having consumed alcohol ('never drinkers', n = 143, 1.5%), and having only consumed very infrequently ('occasional-only drinkers', n = 1149, 12.3%).

RESULTS

67% of never drinkers previously reported drinking, 25% were past weekly/daily drinkers; 56% of occasional-only drinkers reported weekly/daily consumption. The validity of the retrospective items was progressively questionable when presumed to cover longer time periods.

CONCLUSIONS

Substantial measurement error was evident when identifying 'occasional-only' and 'never' drinkers using retrospective items covering the lifecourse. Researchers investigating potential health benefits associated with moderate drinking need to incorporate more sophisticated methods when identifying sub-groups of non-drinkers.

Laryngopharyngeal reflux in patients with symptoms of gastroesophageal reflux disease

Laryngopharyngeal reflux (LPR) has been extensively studied in patients with laryngeal signs and symptoms, gastroesophageal reflux being identified in approximately 50%. Few studies have investigated the incidence and significance of LPR in GERD patients. Two-hundred and seventy-six consecutive patients referred with symptoms of gastroesophageal reflux had dual probe 24 h pH, esophageal manometry, GERD and ENT questionnaires. LPR was defined as at least three pharyngeal reflux events less than pH 5.0 with corresponding esophageal reflux, but excluding meal periods. Fourty-two percent of patients were positive for LPR on 24 h pH monitoring and 91.3% corresponded with an abnormal esophageal acid score. Distal esophageal acid exposure was significantly greater (P < 0.001) in patients with LPR but symptoms of GERD and regurgitation scores showed no significant differences between patients with positive and negative LPR on 24 h pH. There was no significant difference between the incidence of LPR in patients with or without laryngeal symptoms. There is a high incidence of LPR in patients with GERD but its significance for laryngeal symptoms is tenuous. Fixed distance dual probe pH monitoring allows documentation of conventional esophageal reflux and LPR.

The need for a national strategy for chronic pain management in Ireland

BACKGROUND

Chronic pain is defined as pain on a daily basis for more than six months. It affects 13% of the Irish population. Despite its prevalence and the impact on patient's quality of life there is no national strategy for this problem.

AIM

To determine the need for a national strategy for chronic pain in Ireland.

METHODS

The cost of low back pain (LBP) (common chronic pain condition), the level of education and research and current chronic pain clinic resources were investigated.

RESULTS

The cost of LBP in Ireland is enormous: disability payments from the Department of Social and Family Affairs amounted to euros 348 million and insurance payments cost euros 10.5 million. The number of teaching hours timetabled for pain education in the schools of Medicine, Physiotherapy, Dentistry, Nursing and Psychology in Ireland's six universities varied significantly (e.g. 11.5-72 hrs in nursing). Research grants awarded from state organisations were limited to one over a four-year period. No current chronic pain clinics comply with recommended International Association for the Study of Pain (IASP) guidelines.

CONCLUSION

A national strategy is needed to reduce costs, standardise teaching and increase pain clinic resources to maximise patient care.

Physical activity, television viewing and body mass index: a cross-sectional analysis from childhood to adulthood in the 1958 British cohort

OBJECTIVE

To investigate relationships between frequency of physical activity or television viewing and body mass index (BMI) cross-sectionally at six ages from childhood to adulthood, to better understand longitudinal relationships. To investigate how the relationships vary with age and gender and whether any relationships are due to confounding factors.

METHODS

The 1958 British birth cohort includes all births (approximately 17 000) in one week in March 1958. BMI and physical activity frequency were recorded at 11, 16, 23, 33 and 42 y and television viewing frequency at 11, 16 and 23 y. A total of 11 109 subjects provided BMI and activity data at 42 y. Relationships between BMI and (in)activity were investigated using linear regression.

RESULTS

At ages 11, 33 and 42 y in both sexes and at 23 y in female subjects, those who were more active had lower BMIs, and the relationships strengthened with age. At 42 y, the most active had a lower mean BMI than the least active, by 0.83 kg/m2 in men, and 1.03 kg/m2 in women. BMI and activity were unrelated at 16 y in female subjects, and 23 y in male subjects. At 16 y in males, the most active males had a mean BMI 0.25 kg/m2 higher than the least active. At 11 y in female subjects and 23 y in both sexes, those who watched television most frequently had higher BMIs. BMI and television viewing were unrelated at 11 y in males and at 16 y in both sexes. Relationships between BMI and activity or television viewing were largely unexplained by potential confounding factors.

CONCLUSIONS

The relationship between BMI and physical activity changes with age. In early adolescence and in adulthood, a higher activity level, or lower frequency of television viewing was associated with a lower BMI. In later adolescence (16 y), television viewing and activity were unrelated to BMI, except for an unexpected BMI-activity relationship in males. We suspect this relationship in males is primarily due to selection effects, whereby physically bigger boys, with a larger BMI, are more likely to take part in exercise activity, and possibly also to BMI being a less accurate predictor of fatness in adolescent boys.

CNS tuberculosis: a longitudinal analysis of epidemiological and clinical features

In a prospective Canadian cohort of 82 764 patients with tuberculosis (TB), the risk of developing central nervous system manifestations of TB (CNS-TB) (1%) was higher among younger, female, Aboriginal and foreign-born persons (P < 0.005), together with an elevated mortality risk (RR 4.23), compared to controls with only pulmonary TB. TB detection was lower in the CNS-TB group (P < 0.005), while the likelihood of being cured was also reduced (P < 0.005). CNS-TB remains a serious complication of TB in the industrialised world.

Fracture Hematoma Is a Potent Proinflammatory Mediator of Neutrophil Function

BACKGROUND

Patients with multiple skeletal injuries are susceptible to acute respiratory distress syndrome and multiple organ failure, which result from hyperactivation of the immune system. This study was designed to evaluate in vitro the proinflammatory properties of fracture hematoma (FH).

METHODS

FH was isolated from patients undergoing emergent open reduction and internal fixation for isolated closed fractures. Neutrophils (PMNs), isolated from healthy volunteers, were exposed to the FH supernatant and activation was examined (CD11b and CD18 adhesion receptor expression and respiratory burst). PMN phagocytosis, apoptosis, and transmigration across an endothelial barrier were also assessed.

RESULTS

FH increased PMN respiratory burst (control, 100; FH-treated, 186) and phagocytosis (control, 100; FH-treated, 172) but had no effect on adhesion receptor expression. Transendothelial migration of PMNs was unaffected, although FH was toxic to endothelial cells. In contrast, apoptosis of FH-treated PMNs was delayed (control, 46; FH-treated, 8).

CONCLUSION

These effects, although beneficial at the site of injury in the context of antibactericidal function, may cause PMN-mediated tissue injury systemically.

Adolescent drinking level and adult binge drinking in a national birth cohort

AIMS

To assess (i) continuities in binge drinking across adulthood and (ii) the association between adolescent drinking level and adult binge drinking.

DESIGN

Population-based prospective birth cohort.

SETTING

England, Scotland and Wales.

PARTICIPANTS

All births during one week in March 1958 (n = 8520 in analysis).

MEASUREMENTS

Alcohol consumption reported at 16, 23, 33 and 42 years. Binge drinkers were identified by dividing number of units of alcohol consumed in the last week by usual drinking frequency, with limits of >/=10 units/occasion for men and >/=7 for women.

FINDINGS

Four in five cohort members drank alcohol at least twice a month. Prevalences of binge drinking at 23, 33 and 42 years among men were 37%, 28% and 31% and among women 18%, 13% and 14%. Most binge drinkers in adulthood changed drinking status during this period. Nevertheless, binge drinking at age 23 increased the odds of binge drinking at 42 years: odds ratio (OR) 2.10 (95% CI 1.85, 2.39) for men; OR 1.56 (95% CI 1.29,1.89) for women. Women who rarely or never drank aged 16 were less likely than light drinkers (0-2 units/week) to binge drink as adults, OR at 23 years 0.65 (95% CI 0.55, 0.77). Men who were heavier drinkers (>/=7 units/week) at 16 years were more likely than light drinkers to binge drink throughout adulthood; at 42 years, OR 1.64 (95% CI 1.33, 2.08).

CONCLUSIONS

Binge drinking is common in British men and women throughout adulthood with continuities between the 20s and 40s. Adolescent drinking has a modest although important association with adult binge drinking.

Unusual Presentation of a Giant Parathyroid Adenoma: Report of a Case

Parathyroid adenomas account for most cases of primary hyperparathyroidism (1 degrees HPT). Certain symptoms and biochemical abnormalities alert the surgeon to their presence, since these benign tumors are rarely evident on physical examination. Moreover, because they are usually very small, preoperative localization using sestamibi scanning or ultrasonography is required to avoid bilateral neck exploration. Parathyroid adenomas rarely attain huge proportions. We report a case of a parathyroid adenoma measuring 8 x 5 x 3.5 cm and weighing 110 g; to our knowledge the greatest mass reported in the literature. Interestingly, despite its huge size it did not cause many of the hypercalcemic symptoms usually associated with larger adenomas, but rather it manifested with symptoms of local pressure, another unusual property of this atypical tumor.

Needle-localised biopsy of impalpable breast lesions: A novel adjunct to surgical technique and specimen mammography

Successful screening programmes have resulted in the more frequent detection of early impalpable breast tumours. Effective surgical management of impalpable lesions demands a precise approach to excision which is currently aided by radiologically guided needle-localisation of the lesion prior to operative removal. The surgical specimen procured is most commonly evaluated for tumour presence by specimen mammography intra-operatively or by histological analysis. The latter is more accurate but requires lengthy laboratory processing, which may result in re-operation if the primary excision is inadequate. Although advocated as the standard of care, specimen mammography remains an imperfect technique. In this article we describe a piece of surgical apparatus which attempts to address some of the concerns associated with specimen mammography. It is an inexpensive compression device which reduces operative time, avoids portable fluoroscopy, increased radiation and the necessity for specialised equipment

Are inequalities in height narrowing? Comparing effects of social class on height in two generations

OBJECTIVE

To determine whether social inequalities in height change across generations.

METHODS

The target population was from the 1958 British birth cohort, all born 3rd-9th March 1958, followed to 1991, and the offspring of one third of this population. Main outcomes were height measured at 7, 11, 16, and 33 years (cohort members) and once at 4-18 years (offspring). Multilevel models applied to associations of social class of origin with (a) child-to-adult growth trajectory (cohort members), (b) height (offspring), and (c) generational height increment.

RESULTS

Height inequalities were observed among cohort members, with differences >2.0 cm at all ages between classes I and II, and IV and V. By adulthood, the difference in mean height had declined significantly in boys and slightly in girls. A secular trend was seen between the two generations. While male offspring had a similar mean height to their fathers in classes I and II, boys in classes IV and V gained 2.1 cm (p<0.001). Height gains of female offspring were evident in all classes, with a greater gain in classes IV and V (non-significant). The social class effect on height was weaker among offspring, with a difference between classes I and II, and IV and V of less than 1 cm.

CONCLUSIONS

Social inequalities in height observed among the cohort weakened substantially in the next generation due to a greater height gain among offspring from manual classes. Inequalities in childhood height have narrowed between the two generations in this study.

Childhood disadvantage and health inequalities: a framework for policy based on lifecourse research

Tackling health inequalities is moving up the policy agenda of richer societies like the UK, with governments looking for evidence to guide policy review and development. Observational studies of how childhood disadvantage compromises health in adulthood are an important part of the evidence base, but are largely inaccessible to the policy community. We develop a framework which captures the findings of these studies. Our framework highlights how disadvantage in childhood adversely affects both socio-economic circumstances and health in adulthood through a set of interlocking processes. Key among these are children's developmental health (their physical, cognitive and emotional development) and health behaviours, together with the associated educational and social trajectories. In breaking down the link between childhood disadvantage and adult health into its constituent elements, the framework provides a basis for understanding where and how policies can make a difference. The paper argues that the process of policy review and development needs to include both new programmes and the mainstream policies in which they are embedded.